Medicare AdvantagePrior AuthMedium impact
Medical policy updates
Blue Cross Blue Shield of Rhode Island·RI · Oncology, Dermatology, Gastroenterology·Physician / Facility
Effective date
Jul 1, 2024
We identified it
Jun 19, 2026
Summary
Three medical policy changes are taking effect between July and August 2024: prior authorization is being removed from gene expression profiling for cutaneous melanoma (CPT 0089U), medical criteria for cancer minimal residual disease testing is being simplified, and hemorrhoidal embolization with HydroPearl microspheres will no longer be covered.
Action Required
By July 1, 2024: Billing team must update system to remove prior authorization requirements for CPT code 0089U (gene expression profiling for cutaneous melanoma) for Medicare Advantage and commercial plans. Update encounter forms and billing software rules to process as covered service without prior auth. By August 1, 2024: Update billing system to flag hemorrhoidal embolization procedures as non-covered for Medicare Advantage and not medically necessary for commercial products.